[Congressional Record (Bound Edition), Volume 159 (2013), Part 7]
[House]
[Pages 10443-10446]
[From the U.S. Government Publishing Office, www.gpo.gov]




           JOBS, SECURITY, AND THE WELL-BEING OF THE COUNTRY

  The SPEAKER pro tempore (Mr. Pittenger). Under the Speaker's 
announced policy of January 3, 2013, the Chair recognizes the gentleman 
from Connecticut (Mr. Larson) for 30 minutes.
  Mr. LARSON of Connecticut. Thank you, Mr. Speaker. I believe I will 
be joined by my colleague from Ohio (Mr. Ryan), whom I will recognize 
at the appropriate time.
  We wanted to make this Special Order this evening about solution-
driven legislation and about the need on behalf of the United States 
Congress to come together in a nonpartisan manner and get after the 
concerns that this Nation cares so deeply about, most notably those as 
they relate to jobs and security and the well-being of the country.
  This evening, Mr. Speaker, what if I told you that we could deal with 
all of the rising costs of health care, bring down the national debt 
and that we could do so while providing better quality, coordinated 
patient-centered care?

                              {time}  1650

  There might be some skepticism. What if I further told you that we 
could do it without raising taxes or cutting Medicare? In fact, what if 
we did it by extending the benefits of Medicare?
  What if I were to tell you, Mr. Speaker, that this idea germinated 
with the Heritage Foundation, a conservative organization dedicated to 
conservative ideas, and was piloted by a Republican Governor in a 
Democratic State and served as the basis for what we now call the 
Affordable Health Care Act?
  The Affordable Health Care Act, in its final form, was something that 
a number of colleagues on the Democratic side didn't necessarily 
prefer. It was not their first choice. A number wanted to see a single-
payer system or Medicare for all, but that is not what transpired and 
that is not what is the law of the land nor is what is upheld by the 
Supreme Court.
  We need, in this body, a paradigm shift that will allow us to come 
together and embrace the ideas that we all agree upon in a way that we 
can move this Nation forward. The budget leader in the Republican 
conference is Paul Ryan, a distinguished, bright, and capable 
gentleman. We agree that health care costs are what are driving our 
national debt. There is no doubt about that. Statistics will reveal 
that.
  Further, when it comes to improving patient care, patient outcomes, 
making sure that we provide for our elderly, making sure that we have a 
continuum of care for people, that's something that's neither Democrat 
nor Republican. That's something that is truly American and that we all 
agree on.
  Where we may disagree but where we can come together is in 
recognition of how we get to the solution, solve this problem, instead 
of these endless ``tastes great, less filling'' debates that go on in 
the United States Congress. To do so, you have to be bolstered by 
studies.
  This slide will show that there are no less than 10 different studies 
that have been authored by private sector individuals that all point to 
one thing: that there's $750 billion to $800 billion annually that's 
wasted in fraud, abuse, and inefficiencies.
  This evening, we want to focus on the inefficiencies, noting of 
course that fraud, abuse, and waste are very important, have been 
documented several times on ``60 Minutes'' and other notable sources as 
well, and certainly is something that will help us in terms of bringing 
down the costs of health care, which, of course, solves our problems 
with the national debt.
  Health care costs in the United States of America have risen to 18 
percent of our gross domestic product. This next slide will demonstrate 
clearly that we are way above every other Western democracy, and this 
is what the inefficiencies of a system have produced: a hodgepodge 
system that is inefficient and driven upward in its cost because of the 
lack of coordinated care and outcomes that suggest a new paradigm shift 
and people coming together and embracing that which is in the public 
health care system that works and does extraordinarily well, all that's 
in the realm of science, technology, and innovation that we get from 
the National Institutes of Health and for the Centers for Disease 
Control that have been taxpayer funded and produced miraculous 
opportunities and a better quality of life.
  Then, thirdly, to embrace that with the private sector, 
entrepreneurial efforts to drive inefficiencies out of a system. This 
chart demonstrates how that can be done and that there is both the 
profit in doing it for the private sector and the results of lowering 
that cost for the public sector and an outcome for patients that is 
centered around wellness, their well-being and their security in the 
later years of their life. It's that combination that we believe can 
work.
  How do we know that that is so? We're fortunate to see, even in this 
time of politics where there has been disagreement and too much 
politics around the quality of health care, that our citizens rightly 
deserve and the private sector in our hospitals with our doctors, with 
our surgeons, with our medical devices, and with our entrepreneurship 
are coming to embrace. The passage of the Affordable Health Care Act 
is, in fact, a paradigm shift.
  What do we need to shift to? How do we need to move that forward? 
Mark Bertolini, the president of Aetna, based in Hartford, Connecticut, 
said that the one thing we have to make sure of is that we're not 
taking away benefits from people who are going to pay for the medical 
devices--the hospitals, the doctors, the insurance, and the 
pharmaceuticals that they all need. We need to enhance that system.
  Economists like Clayton Christensen have talked at length about how 
we need to be disruptive in economies, and

[[Page 10444]]

in doing so, disruptive in terms of our innovation. With the genomic 
projects at hand and the potential for people to be living well beyond 
the age of 100 for my children and for current generations, as we all 
know obviously living longer, there's a need for us to embrace 
commonsense solutions and not issues that either say we have to drive 
down the debt at the expense of beneficiaries or that we have to raise 
taxes to help the beneficiaries.
  How about we drive out the inefficiencies within the system, get 
after the fraud, abuse, and the waste, and work together as Democrats 
and Republicans and achieve the goals that we were sent here to do by 
both lowering the national debt and securing the future by making sure 
that there is Medicare there for all of our recipients?
  I think of so many people nearing the age of retirement who get 
trapped in this gap. Once you turn 56, you start thinking, Is my 
company going to keep me to age 65? What is going to happen to my 
pension? But most importantly, what is the bridge I'm able to take to 
get to Medicare and will it be there? There's got to be a resounding 
``yes,'' and the important thing is that there's a path forward to 
this.
  Two things that are important to remember:
  One, that the national debt is real and that we all agree that it has 
to be addressed, and the primary driver is health care;
  Secondly, Medicare is not an entitlement. It's the insurance that 
people paid for. It's taken out of your paycheck. And if we drive the 
inefficiencies out of the system, we actually can enhance the Medicare 
system and make it solvent well into the future while paying down our 
national debt.

                              {time}  1700

  That should be the focus of the United States Congress. It will help 
the economy, but most of all, it will help people in terms of the 
quality of care that they need. This is what we hope to achieve in 
Special Orders and prevailing upon our colleagues on both sides of the 
aisle to come together and discuss solutions that will both reduce the 
debt and preserve the Medicare system.
  A person who understands this better than most, who has made 
firsthand trips to hospitals and has written books, in fact, or at 
least a book, as I seek to credit you beyond your authorship, Mr. Ryan, 
but certainly someone who understands the importance of coordinating 
care in such a manner that an enlightened new Republic that we are will 
be able to participate in the wholeness and wellness that can come from 
this paradigm shift afforded by the Affordable Care Act, and where 
reasonable minds can come together to achieve these goals. I yield to 
my colleague, the gentleman from Ohio (Mr. Ryan).
  Mr. RYAN of Ohio. I thank the gentleman, and I would like to say a 
deep thank you because I think this is one of the key issues that we 
need to address as a country in order to have healthier citizens, have 
a healthier economy, and drive down the national debt. As you said so 
eloquently, the big driver for our national debt and deficits are the 
Medicare and Medicaid programs, issues dealing with health. Look at 
what is weighing down businesses right now. Small businesses 
especially, huge increases in health care, year in and year out--10, 
15, 20, 30 percent. We've all had people come to our office and say, 
Hey, it went up 90 percent this year. How am I supposed to plan for 
capital investments? I want to buy a new machine, and on and on and on 
and on.
  Where we start is, the current health care system is not working. We 
spend $8,000 per capita in the United States versus $3,000 in 
developing countries, and we have worse outcomes. We have worse 
outcomes here. What we're talking about, what the CEO of Aetna is 
talking about, is how do we take this system and recognize and begin to 
appreciate in 2013 in America that if we put some money into 
prevention, if we pay doctors and nutritionists and dieticians on the 
front end, we're going to save a boatload of dollars on the back end. 
Seventy-five percent of health care costs go to chronic diseases that 
are mostly preventable.
  So here we are bogged down by a system when the answer is patient-
centered care and having people participate in their own health care. 
This is a challenge to every American to take responsibility for their 
own health, their own well-being, and to create a system that 
incentivizes everyone who is in the system to operate in this fashion 
and help drive down health care costs in the long run. We all know this 
intuitively, that if you take care of yourself, your diet matters, your 
nutrition matters, your exercise matters, your checkups matter, and 
through the Affordable Care Act, by having everybody covered, it begins 
to change that business model of having the insurance company 
incentivized to keep and help people get and stay healthy. I think it's 
time for us to take the advice of the CEO of Aetna. This isn't John 
Larson, this isn't me. We're looking at the statistics here in our 
country, and we have to say, This is unacceptable. We have so many sick 
people in our country, and we are doing nothing to prevent them from 
getting sick in the first place.
  Mr. LARSON of Connecticut. It isn't just the CEO of Aetna. As I was 
pointing out earlier, a number of studies, whether they be done by 
Reuters, whether they be done by Dr. Blumenthal and a number of groups 
focused on this issue, they all arrive at the same conclusion: the 
system is inefficient in its form, and how do you improve that system. 
We're at a fork in the road here, as Dr. Blumenthal from the 
Commonwealth Fund points out. Health care policy, we either are going 
to end up in a situation, as the poster points out, where we cut 
payments, reduce benefits, and restrict eligibility for public 
programs, or we re-engineer health care and improve the health care 
costs, improve the outcomes for patients.
  As Mark Bertolini from Aetna says, the answer lies not in cutting 
people's benefits but in improving their care. This is the juncture 
that we're at. It would seem to me that, especially in this body, that 
we now have an opportunity. We all agree that the national debt is a 
problem. We know that health care is the primary domestic driver of 
that debt. We have an opportunity to change that. We have a structure, 
the framework of which, as I said in my opening remarks, was provided 
by the Heritage Foundation and was pioneered by Mitt Romney in 
Massachusetts as Governor, and done successfully.
  Let's expand on that opportunity, only make it better. Make it better 
because we know the great virtue of public health and all it has meant 
for the wellness of this country. We know the great strength of our 
hospitals and doctors and our scientific community, our innovators, our 
manufacturers, our medical devices, our pharmaceutical companies, we 
know the great genomic project that is going to have remarkable 
abilities that are going to enhance the quality of life like we have 
never seen it before.
  Instead of arguing the old wars and the last battles, we have to be 
embracing the future in a way that makes the American citizenry secure 
in the outcome of knowing that science, technology, and innovation, 
their government and the best of the private sector, are all working on 
their side. It's not a question of choosing one or the other; it's 
embracing all three in a way that both lowers the costs, demonstrated 
in study after study after study, and that will also enhance the 
quality of health for our individuals. So many people in Ohio, I know, 
have problems that have dealt with this.
  Mr. RYAN of Ohio. And to figure out how to target the technology. We 
were out at Walter Reed a few weeks ago, going through and seeing all 
of the various techniques and approaches that are being used for our 
veterans that are coming back, and they talk about having high-tech 
health care, high-touch health care. A good portion of our health care 
costs are driven up by the sickest 1 percent of the people, and the top 
5 percent of the people in health care are driving a lot of the costs.
  Mr. LARSON of Connecticut. Fifty percent of the costs.

[[Page 10445]]


  Mr. RYAN of Ohio. From the top 5 percent. So 5 percent of the people 
drive 50 percent of the health care costs. I think what a lot of these 
folks are finding out, if you can surround that patient, the patients 
in the center and figure out exactly what's going on and make sure that 
that patient has preventive care and a consistent doctor and a 
consistent nurse and somebody to consistently make sure that they are 
taking their medication, these techniques, these medical homes, these 
accountable care organizations, to surround the patient to make sure 
that they get better, and then reward the doctor and the nurses and 
everybody, the hospital, everybody who is involved for saying, we're 
not going to pay you the same amount of money every time you see this 
patient that still has the same problem that they had from the first 
time they came in; you will be paid to make them healthy. And that 
begins to shift the incentive and squeeze some of that excess out of 
the system that the gentleman from Connecticut talked about.

                              {time}  1710

  Mr. LARSON of Connecticut. Well, you know, inefficiencies, as I said, 
were going to be our focus. Let's talk about that just from a practical 
standpoint.
  You say the word ``inefficiency'' and what do people actually think?
  Think about the last time you were in any doctor's office, or made 
any trip to the emergency room, and the number of forms you had to fill 
out, the number of forms where we have complicated a system that needs 
to be streamlined.
  One of the things that our colleagues and I should embrace is the 
need for us to streamline regulation in the process so that it becomes 
simple, cost-effective, electronically or digitally driven in a way 
that both reduces costs and adds to a better quality of life for the 
individual.
  When Mr. Bertolini speaks, he talks about, as you point out, 
developing coordinated care with our areas, our centers of expertise. 
Whether it's the Mayo Clinic or, in Ohio, the Cleveland Clinic, or 
whether it's Sloan Kettering, whether it's Jackson Labs in the State of 
Connecticut, by working in conjunction and coordinating the best 
outcomes, and then also doing this locally, from the bottom up, that 
coordination, quite frankly, hasn't existed before. That's what's 
driven our health care costs up so dramatically.
  No other Western democracies in the world, some that have more aging 
populations than we do, face a similar crisis. We have the opportunity 
to attack this like no other nation in the world.
  Just a word about the genomic project. Jackson Labs is located in my 
district in Connecticut, and they're known for their Nobel Prize 
winners because of what they have been able to do with mice.
  Mice, as I know the gentleman from Ohio knows, because of their lack 
of an immune system, allow them to be great vehicles to test with 
respect to breakthroughs in disease and how we deal with disease.
  Well, when we add the genomic project to that, and the advances that 
we can make in cancer, heart disease, diabetes, all of the areas that 
plague us, we now have, at our disposal, but instead of a multitude of 
tests, and random testing, we can now get down to an individual's DNA 
and make that change.
  That is enormous cost savings. That is the full embrace of science 
and technology and innovation. That should be the discussion on the 
floor here, the greatest breakthroughs and what we're going to do, and 
how it's American ingenuity, it's American innovation, it's American 
doctors and surgeons and medical manufacturers and medical devices and 
chemistry, through pharmaceuticals and all the science that we've 
brought to bear.
  We put a man on the Moon in less than 10 years. Can we solve this 
problem?
  Of course we can. And it's on the cusp of being solved.
  Let's embrace what the private sector is doing. Let's embrace our 
scientific and university communities and our labs in a way that we're 
coordinating with them, coordinating in a way that we drive out the 
inefficiencies, because our end goal here is the consumer, it's the 
patient, it's the citizen of this country who's paid tax dollars for 
this, who's bought into an insurance system, who believes that his 
country, or she believes that her country, is there for them in their 
time of need as we make these critical transitions.
  The American people want to see us here in this body working 
together. Let's work around the issues that drive us, the national 
debt, securing Medicare for the future, and understand that we have the 
tools, many of which we owe to the public health system, and the 
innovation, the labs, the Centers for Disease Control, the National 
Institutes of Health, and all that's been done in our universities, as 
well as the entrepreneurial expertise and the creation and innovation 
that comes from our great system.
  Let's enjoin that in a way that we solve problems, solution-oriented 
legislation that gets over the ideological divide and recognizes that 
we need common outcomes on behalf of the American people.
  Mr. RYAN of Ohio. And, I think, take what is working in areas 
systemically, but also techniques. Up at Walter Reed, for example, 
they're using things like acupuncture. They're using things that can 
help with stress reduction. They're using mindfulness-based stress 
reduction because we now know, in 2013, given all of the brain science, 
all of the research that the neuroscientists have done all over the 
country and the world, Dr. Richard Davidson, at the University of 
Wisconsin, and Dr. Amishi Jha, at the University of Miami, all of the 
greatest institutions in the United States and the scientists that run 
these labs, that study the body, study the mind, they know that the 
future of health care is self-care.
  How do we help people reduce their stress?
  How do we help some of these soldiers that come back that are on 6, 
8, 10, 12 drugs?
  We spend $300 billion a year on pharmaceuticals. That's more than 
many of the other countries in the world combined. And we're not saying 
that you shouldn't have prescription drugs, because you're going to 
need them in this system that appreciates and tries to utilize all of 
the tools in the toolbox to keep people healthy.
  But how do we create a system where a doctor can have more than 5 
minutes with a patient?
  And it's on to the next one and on to the next one and on to the next 
one. That's not a system. That is not protecting the integrity of the 
doctor/patient relationship. And that, in and of itself, can be a 
healing relationship, being able to sit down with the doctor and find 
out what's wrong.
  How much stress and anxiety do people have when they just don't know 
what's wrong?
  Mr. LARSON of Connecticut. The gentleman makes excellent points; and 
it's a point that underscores that, within this system, as the 
gentleman points out, we are going to need that high quality of care.
  But our care coordination problems have been driven by flawed 
designs. The coordination of care in the new era, with all the science, 
technology and innovation that we can bring to bear on this problem, 
and the flawed design of our payment systems, are what we need to 
correct.
  The beneficiaries will not only be our veterans who return home and 
are in need of our care, but our general population in dealing with 
this. The exchange is going to present a great opportunity, an 
opportunity to have a paradigm shift, an opportunity for us to come 
together and solve major problems.
  And you know what? As the gentleman from Ohio knows, if we solve the 
national debt problem, then we don't have an issue with sequester, we 
don't have an issue with debt ceilings, and we can get about the 
infrastructure system that we desperately need in this country to 
further enhance jobs.
  But within the innovation, technology, and manufacture of drugs and 
of medical devices, and the technology that grows out of health care, 
we have a whole economy that's ready to burst and boom as well.

[[Page 10446]]

  That's what we've got to be about. That's what I believe the American 
people want to see us solving. And I'm glad that we've taken the time 
this evening to do that.
  Mr. RYAN of Ohio. And if you think about what the small business 
person who's suffered the brunt of these huge health care increases 
over the last decade or two, 120-some percent increase, I think, in the 
last 10 years for a small business person, their health care, over that 
period of time has gone up.
  So if you start reducing that cost, the money that business person 
will have to reinvest can be a stimulant for the economy.
  Mr. LARSON of Connecticut. I thank the gentleman. I see that our time 
has expired. I thank the Speaker, and we thank everyone for the 
opportunity to lay out this case of coordinated care and cooperation, 
reducing our national debt, and securing Medicare for our citizens.
  I yield back the balance of my time.

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